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Migraines treatments and therapies

Treatments for pediatric migraines and likely outcomes.

We sat with Dr Amaury Salavert, an authority in pediatric migraines, for a 5 min exchange on migraines.

This is part 2 where we discuss the various treatments, their risks and outcome. For a migraine overview, see part 1.


What medications are available to treat pediatric migraines?

For pediatric migraines, let's differentiate between crisis care and preventive care. Crisis medication requires pharmaceutical medication. The quicker you take it, the better. For crisis care there are two types of medications available: anti-inflammatory medications, such as ibuprofen, and vasoconstrictors, such as triptans. Note that in pediatric population under 12, you can use only non-steroids anti-inflammatory drugs. Caffeine may also be tried as a potential treatment.

How about preventive treatments?

For preventive care no pharmaceutical medication has proven to be effective in pediatric populations. So the best way to prevent migraines is to focus on lifestyle changes, such as learning how to manage emotions or on alternative medicine that reduces stress.

What are the potential side effects of the medications you just mentioned?

When prescribing ibuprofen and triptans, it is important to take into account potential side effects, allergies, and age. Ibuprofen can cause esophagus, belly ache, or renal failure, as well as headaches if taken too often. Note that renal failure shouldn't happen if you have good kidneys. It's more relevant for adults. Triptans can cause a long list of side effects, but these are rare and tolerated in those over 12 years old. Additionally, those with migraine with aura should consult their gynecologist before taking any of these medications, as certain pills are restricted for this condition.

Are there any alternative medicine for pediatric migraines?

Non-pharmaceutical treatments for pediatric migraines can be helpful in both crisis and prevention. During a crisis, drugs typically take 30 to 45 min to start making an effect. That's a window you want to address with alternative medicine. Applying a cold compress to the head or engaging in relaxation techniques such as auto-hypnosis or meditation can be beneficial. For prevention, alternative therapies such as seeing a psychologist, learning hypnosis, or practicing meditation can be effective in reducing stress levels. Additionally, taking some herbs to reduce anxiety can help to impact the migraine. This is not a treatment in itself, but rather a first step before addressing the migraines triggers with a psychologist.

Any therapies have proven to be highly effective?

Yes, psychologists are often the most effective option. However, this may not be feasible due to cost, family dynamics, or other factors. In these cases, other options such as yoga, sports, or improving sleep habits may be beneficial. If a person has had experience with a particular therapy, it is important to assess how successful it was in order to determine if it is the best option. Ultimately, it is important to find the treatment that works best for the individual.

How long before a patient starts seeing results from such therapies?

Well, first patients have to start the treatment. Typically it will be 3 months before I see a patient again. I often see teenagers who have not taken any action during this period, so I encourage them to come back in three months and we can discuss further. Eventually, they do start taking the necessary steps and begin to see results. Depending on how well they follow the instructions, they can expect to see the best results in three months.

And what kind of results can patient expect?

The reduction in the length and frequency of migraines. These alternative treatments can have huge benefits, as they can reduce the length of a migraine from three days to one hour or one hour and a half.

So they are that good. How about migraines frequency, can they impact that too?

This is more difficult to address. It requires individuals to reflect on their lifestyle and stress levels. To be very aware about it. The best here is families to get involved. But families don't have this level of awareness themselves, so it's hard.

How can family help then?

They can help with the whole lifestyle and stress conversation. When there is a migraine attack, families can help their children by providing a calm environment and reassurance. Turn the lights off, make it quiet. Ultimately, when there is a crisis the best course of action is to wait for the medication to take effect.

Thank you Dr Amaury for this very insightful chat. Loved this conversation. It seems that anxiety plays a big part in migraines. Perhaps we should talk about it in another chat!

Thanks again for having me. Another chat about anxiety sounds great.

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